scholarly journals A structured pathway for developing your complex abdominal hernia service: our York pathway

Hernia ◽  
2021 ◽  
Vol 25 (2) ◽  
pp. 267-275
Author(s):  
O. Smith ◽  
T. MacLeod ◽  
P. Lim ◽  
P. Chitsabesan ◽  
S. Chintapatla
Keyword(s):  
Abdominal Wall ◽  
Clinical Pathways ◽  
Abdominal Wall Reconstruction ◽  
Abdominal Wall Hernia ◽  
Healthcare Services ◽  
Abdominal Hernia ◽  
Current Evidence ◽  
Wall Unit ◽  
Improve Patient ◽  
Over Time

Abstract Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

Hernias in the Emergency Department

2017 ◽  
Author(s):  
Mary C. Westergaard ◽  
Daniel Berhanu ◽  
Ciara J. Barclay-Buchanan
Keyword(s):  
Risk Factors ◽  
Inguinal Hernia ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Abdominal Mass ◽  
Abdominal Wall Hernia ◽  
The United States ◽  
Abdominal Hernia ◽  
Indirect Inguinal Hernia ◽  
Benign Condition

Hernia is defined as an abnormal protrusion of an organ or tissue through a pathologic defect in its surrounding wall. Overall, hernia is common and is generally believed to be a benign condition associated with some morbidity, although it is not thought to be associated with significant mortality. Between 2001 and 2010, 2.3 million inpatient abdominal hernia repairs were performed in the United States, of which 567,000 were performed emergently. In some cases, a hernia can be a deadly condition. In 2002, hernia was listed as the cause of death for 1,595 US citizens. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of hernia. Figures show anatomic locations of the various abdominal wall, groin, lumbar, and pelvic floor hernias; a direct inguinal hernia; an indirect inguinal hernia; point-of-care sonograms showing a ventral wall hernia and an abdominal wall hernia; and the differential diagnosis of an abdominal mass based on anatomic location. Tables list risk factors for the development of inguinal hernia, sex-based differences in inguinal hernia development, risk factors for the development of incisional hernia, factors to consider when assessing the patient for a hernia, and factors associated with the highest rates of incarceration in patients with groin hernia. Key words: emergent hernia, hernia incarceration, incisional hernia, inguinal hernia, strangulated hernia This review contains 6 highly rendered figures, 5 tables, and 66 references.

Hernias in the Emergency Department

2018 ◽  
Author(s):  
Mary C. Westergaard ◽  
Daniel Berhanu ◽  
Ciara J. Barclay-Buchanan
Keyword(s):  
Risk Factors ◽  
Inguinal Hernia ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Abdominal Mass ◽  
Abdominal Wall Hernia ◽  
The United States ◽  
Abdominal Hernia ◽  
Indirect Inguinal Hernia ◽  
Benign Condition

Hernia is defined as an abnormal protrusion of an organ or tissue through a pathologic defect in its surrounding wall. Overall, hernia is common and is generally believed to be a benign condition associated with some morbidity, although it is not thought to be associated with significant mortality. Between 2001 and 2010, 2.3 million inpatient abdominal hernia repairs were performed in the United States, of which 567,000 were performed emergently. In some cases, a hernia can be a deadly condition. In 2002, hernia was listed as the cause of death for 1,595 US citizens. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of hernia. Figures show anatomic locations of the various abdominal wall, groin, lumbar, and pelvic floor hernias; a direct inguinal hernia; an indirect inguinal hernia; point-of-care sonograms showing a ventral wall hernia and an abdominal wall hernia; and the differential diagnosis of an abdominal mass based on anatomic location. Tables list risk factors for the development of inguinal hernia, sex-based differences in inguinal hernia development, risk factors for the development of incisional hernia, factors to consider when assessing the patient for a hernia, and factors associated with the highest rates of incarceration in patients with groin hernia.  Key words: emergent hernia, hernia incarceration, incisional hernia, inguinal hernia, strangulated hernia This review contains 6 highly rendered figures, 5 tables, and 66 references.

scholarly journals Blunt abdominal trauma leading to acute abdominal wall hernia: a case report

2020 ◽  
Vol 5 (1) ◽  
pp. 86-90
Author(s):  
D Sharma ◽  
Santosh Shrestha ◽  
R Ghimire
Keyword(s):  
Case Report ◽  
Abdominal Wall ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Abdominal Wall Hernia ◽  
Abdominal Hernia ◽  
Traumatic Abdominal Wall Hernia ◽  
Traumatic Abdominal Hernia

Acute traumatic abdominal wall hernia is a rare but serious diagnosis resulting from blunt abdominal trauma. The challenge of managing acute traumatic abdominal hernia is approach and timing of repair. We describe a 32 years male patient’s acute traumatic abdominal wall hernia and its management.

Mesh hernioplasty in emergency repair of traumatic abdominal wall hernia following bull horn injury

2021 ◽  
Vol 14 (7) ◽  
pp. e244384
Author(s):  
Arvind Kumar Bodda ◽  
Prakash Kumar Sasmal ◽  
Swastik Mishra ◽  
Ankit Shettar
Keyword(s):  
Abdominal Wall ◽  
Rural Areas ◽  
Motor Vehicle ◽  
Abdominal Wall Hernia ◽  
Abdominal Hernia ◽  
Emergency Setting ◽  
Traumatic Abdominal Wall Hernia ◽  
Vehicle Accidents ◽  
Emergency Repair ◽  
Mesh Hernioplasty

Traumatic abdominal wall hernia (TAWH) is uncommon, mostly following motor vehicle accidents, fall from height and bullfighting. Bullhorn injury, common in rural areas, presents as either penetrating injuries to the abdomen or blunt injuries leading to internal organs injury. Rarely the bull horn injury may lead to TAWH. We report a 70-year-old female from a rural area who suffered bull horn injury to the abdomen leading to TAWH without penetrating the horn and was managed in the emergency by an open mesh hernioplasty. We suture closed the 10×5 cm size defect and reinforced it with a polypropylene mesh of 15×15 cm in the emergency setting. The patient recovered well without any complications or recurrence and doing well at 1 year of follow-up. Mesh hernioplasty can be considered a feasible and safe option in the emergency repair of traumatic abdominal hernia following bull horn injury.

Outcome of Abdominal Wall Hernia Repair with Biologic Mesh: Permacol™ versus Strattice™

2014 ◽  
Vol 80 (10) ◽  
pp. 999-1002 ◽  
Author(s):  
Amy W. Cheng ◽  
Maher A. Abbas ◽  
Talar Tejirian
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Hernia Recurrence ◽  
Biologic Mesh ◽  
Abdominal Hernia ◽  
Complication Rates ◽  
Short Term ◽  
Porcine Dermis ◽  
Abdominal Wall Hernia Repair

The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. Numerous biologic products are available with virtually no clinical comparison studies. A retrospective study was conducted to compare patients who underwent abdominal wall hernia repair with Permacol™ (crosslinked porcine dermis) and Strattice™ (noncrosslinked porcine dermis). Of 270 reviewed patients, 195 were implanted with Permacol™ and 75 with Strattice™. Ventral hernia repairs comprised the majority (85% for Permacol, 97% for Strattice™). Postoperative infection rate was lower in the Strattice™ group (5 vs 21%, P < 0.01). In the Permacol™ group only, the overall complication rates were significantly higher in patients with infected versus clean wounds (55 vs 35%, P < 0.05) and in obese patients (body mass index 40 kg/m2 or greater [57 vs 34%], P < 0.01). Short-term complication and recurrence rates were higher when mesh was used as a fascial bridge: 51 versus 28 per cent for Permacol™, 58 versus 20 per cent for Strattice™. The hernia recurrence was similar in both groups. In this review of patients undergoing abdominal hernia repair with biologic mesh, Strattice™ mesh was associated with a lower short-term complication rate compared with Permacol™, but the hernia recurrence rate was similar.

scholarly journals Europos išvaržos asociacijos (EHS) pasiūlyta pilvo sienos išvaržų klasifikacija

2009 ◽  
Vol 7 (3-4) ◽  
pp. 0-0
Author(s):  
Sigitas Tamulis
Keyword(s):  
Inguinal Hernia ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Umbilical Hernia ◽  
Abdominal Wall Hernia ◽  
Abdominal Hernia ◽  
Epigastric Hernia ◽  
Surgical Practice ◽  
European Hernia Society ◽  
Hernia Inguinal

Sigitas TamulisVilniaus universiteto Gastroenterologijos, nefrourologijos ir chirurgijos klinika, Bendrosios chirurgijos centras, Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Šiuo metu Lietuvos chirurginėje praktikoje vartojama daug įvairių pilvo sienos išvaržų klasifikacijų, tačiau nėra vienos paprastos, unifikuotos, informatyvios, išsamios ir kartu lengvai atsimenamos išvaržų klasifikacijos. Tai sunkina gydymo rezultatų vertinimą, naujų gydymo būdų diegimą ir integraciją į Europos ir pasaulio pilvo sienos išvaržų diagnostiką, gydymą ir klinikinius tyrimus. Šio darbo tikslas – apžvelgti iki šiol naudotas klasifikacijas ir pateikti EHS klasifikaciją. Reikšminiai žodžiai: pilvo siena, išvarža, pirminė pilvo sienos išvarža, pooperacinė pilvo sienos išvarža, bambos išvarža, kirkšninė išvarža, epigastrinė išvarža, baltosios pilvo linijos išvarža, juosmeninė išvarža, Špigelio išvarža, pilvo sienos išvaržų klasifikacija. The european hernia society (ehs) abdominal hernia classification Sigitas TamulisVilnius Universitety, Clinic of Gastroenterology, Nephrourology and Surgery, Vilniaus University Emergency Hospital,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] A number of abdominal wall hernia classifications are used in surgical practice in Lithuania. However, there is a lack of one simple, practical, informative, well memorizable, unified and integrated classification intended for all the surgical society. The purpose of this article was to review the abdominal wall hernia classifications commonly used in Lithuania and to present the new abdominal hernia classification proposed by the European Hernia Society. Key words: abdominal wall hernia, inguinal hernia, classification, incisional hernia, ventral hernia, umbilical hernia, epigastric hernia.

The Impact of Mesh Reinforcement with Components Separation for Abdominal Wall Reconstruction

2018 ◽  
Vol 84 (6) ◽  
pp. 959-962 ◽  
Author(s):  
Seyed Amirhossein Razavi ◽  
Karan A. Desai ◽  
Alexandra M. Hart ◽  
Peter W. Thompson ◽  
Albert Losken
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Abdominal Wall ◽  
Recurrence Rate ◽  
Abdominal Wall Reconstruction ◽  
Abdominal Hernia ◽  
Fascial Closure ◽  
Site Infection ◽  
Components Separation ◽  
The Impact

The goal in abdominal wall reconstruction (AWR) is to minimize morbidity and prevent hernia recurrence. Components separation and mesh reconstruction are two options, however, with advantages and disadvantages. The purpose of this review was to investigate outcomes in patients with abdominal wall hernia undergoing primary closure with component separation (CS) versus CS with acellular dermal matrix (ADM) reinforcement (CS + mesh). Medical records of consecutive patients who underwent abdominal wall reconstruction using CS with or without ADM reinforcement were retrospectively reviewed. Primary fascial closure was achieved in all patients. ADM reinforcement when used was performed using the underlay technique. Reconstructive technique and postoperative complications including delayed healing, skin necrosis, fistula, seroma, hematoma and surgical site infection, recurrence, and reoperation were recorded. Comparisons between the two groups were assessed. One hundred and seven patients were included (mean age, 55.7; 51.4% male; median follow-up 297 days). Twenty-six patients (24%) underwent CS alone; whereas 81 patients (76%) CS + mesh placement. Patient comorbidities, including smoking (26%), diabetes (20%), and hypertension (46%); body mass index (mean 32.3 ± 7.6); and albumin level on the day of surgery (mean 3.4 ± 0.5 mg/dL) were not significantly different between groups. Surgical site infection was significantly higher among CS + mesh patients (22.2%) versus CS only patients (3.9%) (P = 0.02). The recurrence rate of abdominal hernia was significantly lower in CS + mesh patients compared with CS only (14.8% vs 34.6%; P = 0.02). No significant differences in other postoperative complications were identified between the two groups. ADM reinforcement at the time of components separation is often selected in more complex, higher risk patients. Although the incidence of infection was higher in these patients, it was usually treated without mesh removal and recurrence rate was significantly lower when compared to CS alone.

scholarly journals ABDOMINAL WALL RECONSTRUCTION BY BILATERAL TRANSVERSUS ABDOMINIS RELEASE – A MASTERLY PROCEDURE

2020 ◽  
pp. 10-11
Author(s):  
Anirban Bhunia ◽  
Soumyajyoti Panja
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Abdominal Hernia ◽  
Posterior Component Separation ◽  
Loss Of Domain ◽  
Ventral Incisional Hernia ◽  
Operative Recovery ◽  
Transversus Abdominis Muscle

BACKGROUND: In ventral hernia repair, closure of the defect is one of the most significant challenges, especially in a wide defect, large hernias with loss of domain, and recurrent hernias. Posterior component separation with transverses abdominis muscle release (TAR) is a novel approach that offers a solution for complex ventral hernias. AIMS AND OBJECTIVES: To assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernia with loss of domain. METHOD: The posterior component separation by transversus abdominis muscle release (simply TAR) is a modification of the Rives-Stoppa procedure which combines it with developing of a large retro-muscular/pre-peritoneal plane and a consistent medial advancement of the abdominal wall musculature and accompanying fascia. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. RESULT: We used this procedure in a case of large median ventral incisional hernia. Our patient was a known post-operative case of exploratory laparotomy for ileal perforation following blunt abdominal trauma. Ileostomy was done due to gross intraperitoneal contamination. His post-operative recovery was complicated by wound dehiscence previously. Patient presented with a hernia along the midline wound with a gap of 12*7 cm. After the abdominal wall reconstruction procedure (TAR) with mesh placement over posterior rectus sheath (15*20cm) his post op recovery was uneventful. There was no recurrence till follow up of 3 months. CONCLUSION: TAR seems to be the effective approach for complex hernias with good immediate outcomes.

Hernias in the Emergency Department

2016 ◽  
Author(s):  
Daniel Berhanu ◽  
Ciara J. Barclay-Buchanan ◽  
Mary C. Westergaard
Keyword(s):  
Risk Factors ◽  
Inguinal Hernia ◽  
Incisional Hernia ◽  
Abdominal Wall ◽  
Abdominal Mass ◽  
Abdominal Wall Hernia ◽  
The United States ◽  
Abdominal Hernia ◽  
Indirect Inguinal Hernia ◽  
Benign Condition

Hernia is defined as an abnormal protrusion of an organ or tissue through a pathologic defect in its surrounding wall. Overall, hernia is common and is generally believed to be a benign condition associated with some morbidity, although it is not thought to be associated with significant mortality. Between 2001 and 2010, 2.3 million inpatient abdominal hernia repairs were performed in the United States, of which 567,000 were performed emergently. In some cases, a hernia can be a deadly condition. In 2002, hernia was listed as the cause of death for 1,595 US citizens. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of hernia. Figures show anatomic locations of the various abdominal wall, groin, lumbar, and pelvic floor hernias; a direct inguinal hernia; an indirect inguinal hernia; point-of-care sonograms showing a ventral wall hernia and an abdominal wall hernia; and the differential diagnosis of an abdominal mass based on anatomic location. Tables list risk factors for the development of inguinal hernia, sex-based differences in inguinal hernia development, risk factors for the development of incisional hernia, factors to consider when assessing the patient for a hernia, and factors associated with the highest rates of incarceration in patients with groin hernia.  Key words: emergent hernia, hernia incarceration, incisional hernia, inguinal hernia, strangulated hernia This review contains 6 highly rendered figures, 5 tables, and 66 references.

scholarly journals 173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Woffenden ◽  
D Vijayan ◽  
E Stevens ◽  
F Ghini ◽  
M Cunha ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Early Years ◽  
Transversus Abdominis ◽  
Electronic Patient Records ◽  
Tertiary Centre ◽  
Wall Unit ◽  
Abdominal Operations

Abstract Background It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry. Method This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data. Results 185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic. Conclusions The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.

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